MEDICARE: TRINITY SURGICAL ASSOCIATES P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	ME80320	FL

General Provider Information

NPI Number	:	1578885646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY SURGICAL ASSOCIATES P A

Provider Business Mailing Address
First Line	:	5719 HIGH ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4036
Country	:	US
Telephone Number	:	727-845-1406
Fax Number	:	727-847-0489

Provider Business Practice Location Address
First Line	:	5719 HIGH ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4036
Country	:	US
Telephone Number	:	727-845-1406
Fax Number	:	727-847-0489

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DWAYNE FELIX LEDESMA
Credential	:	M.D.
Telephone Number	:	727-845-1406

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	04/23/2010

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